Effect of Exergame on Pain, Function, and Quality of Life in Shoulder Impingement Syndrome: A Prospective Randomized Controlled Study

Objective: This study aimed to investigate the effect of a virtual reality (VR)-mediated gamified rehabilitation program added to a home exercise program on pain, functionality, and quality of life in shoulder impingement syndrome. Methods: Forty-eight participants with shoulder impingement syndrome were included in this prospective, randomized, single-blind study between January and July 2022. The participants were randomized into two groups: the VR group (n = 24) and the control group (n = 24). All participants were given a home exercise program for 3 weeks, with five sessions per week. The participants in the VR group received 15 sessions (45 minutes each session) of a gamified shoulder exercise program with an immersive VR headset, while those in the control group received 15 sessions (45 minutes each session) of supervised therapeutic exercises. The participants were evaluated and compared before and after treatment using the 36-item Short Form Survey (SF-36), range-of-motion (ROM) measurements, the Visual Analog Scale (VAS), and the Shoulder Pain and Disability Scale (SPADI). Results: At the baseline assessment, the two groups were homogenous regarding demographic and clinical parameters. The post-treatment shoulder extension and adduction ROM was significantly greater in the VR group and the post-treatment pain subscales for SPADI and SF-36 were significantly lower in the VR group. Conclusion: In individuals with shoulder impingement syndrome, a VR-mediated gamified exercise program added to a home exercise program increased shoulder ROM and reduced pain scores. Further clinical studies are needed to prove the long-term efficacy of the addition of VR-mediated gamified exercises to the treatment of this condition in clinical settings.

Measuring tactile sensitivity and mixed-reality-assisted exercise for carpal tunnel syndrome by ultrasound mid-air haptics

Introduction

Carpal tunnel syndrome (CTS) is the most common nerve entrapment neuropathy, which causes numbness and pain in the thumb, the index and middle fingers and the radial side of the ring finger. Regular hand exercises may improve the symptoms and prevent carpal tunnel surgery. This study applied a novel ultrasonic stimulation method to test tactile sensitivity in CTS and also a mixed-reality-assisted (MR-assisted) exercise program which measured hand movements and provided haptic feedback for rehabilitation.

Methods

Twenty patients with mild unilateral CTS took part in the experiments. A mid-air haptics device (Ultrahaptics STRATOS Explore) was used to apply amplitude-modulated ultrasound waves (carrier frequency: 40 kHz) onto the skin to create tactile stimulation mechanically. Participants performed a two-alternative forced-choice task for measuring tactile thresholds at 250-Hz modulation frequency. They were tested at the index fingers and the thenar eminences of both hands. Additionally, 15 CTS patients used an MR-assisted program to do hand exercises with haptic feedback. Exercise performance was assessed by calculating errors between target and actual hand configurations. System Usability Scale (SUS) was adopted to verify the practical usability of the program.

Results

Thresholds at the thenar eminences of the affected and healthy hands were not significantly different. While the thresholds at the healthy index fingers could be measured, those of the affected fingers were all higher than the stimulation level produced by the maximum output from the ultrasound device. In the exercise program, a significant positive correlation (ρ = 0.89, p < 0.001) was found between the performance scores and the SUS scores, which were above the criterion value established in the literature.

Discussion

The results show that thenar tactile sensitivity is not affected in mild CTS as expected from the palmar cutaneous branch of the median nerve (PCBm), but index finger threshold is likely to be higher. Overall, this study suggests that mid-air haptics, with certain improvements, may be used as a preliminary test in the clinical setting. Moreover, the device is promising to develop gamified rehabilitation programs and for the treatment follow-up of CTS.

Exercises for fibromyalgia syndrome: what YouTube tells us as a source of information for patient and physician education

OBJECTIVE

YouTube, a popular worldwide source to access health information online, may have an impact in enhancing exercise therapy for fibromyalgia patients. This study is aimed to investigate the quality and reliability of exercise videos prepared for fibromyalgia syndrome on YouTube.

METHODS

A thorough search on YouTube using six search terms related to fibromyalgia treatment and exercise was conducted. The videos with content on exercises for fibromyalgia, acceptable audio-video quality, and are in English language were included, whereas duplicates were excluded from the analysis. Quality was determined using the Global Quality Scale (GQS) and JAMA system, and reliability using the mDISCERN criteria.

RESULTS

Out of a total of 600 videos, 70 videos that met the inclusion criteria were included in the analysis. Physicians were found to produce content mostly in high and medium quality (%70.2), other medical professionals mostly in low and medium quality (93.8%), while non-medical users mostly in low quality (86.7%). Ninety percent of the videos targeted patients, while 10% targeted healthcare professionals as an audience, and the majority (93.7%) of videos targeting patients were of low and medium quality, as most (85.7%) of the videos targeting healthcare professionals were of high quality.

CONCLUSION

YouTube can be used as a tool to increase exercise adherence in fibromyalgia patients, as it offers a wide range of content that is easily accessible and useful at times. To implement this tool, physicians need to upload more content online as they stand for pioneers of high-quality information dissemination on the internet. KeyPoints • This research emphasizes the need for high-quality online healthcare information which is accessed by a vast number of individuals and the implementations that effectively address and prevent the spread of misinformation. • Additionally, it presents suggestions for the future regarding the uploading of such content on the internet. • Physicians hold the key responsibility in ensuring the availability of high-quality online health content, thereby carrying significant implications for its overall impact.

Validation of the Turkish Chronic Pain Acceptance Questionnaire-8

Objectives

The aim of this study was to test the validity of the Turkish version of the Chronic Pain Acceptance Questionnaire (CPAQ)-8.

Patients and methods

This methodological and cross-sectional study was conducted with 80 female patients (mean age: 49.5±10 years; range, 28 to 75 years) diagnosed with fibromyalgia syndrome between January 2020 and December 2021. Participants completed the Turkish version of the CPAQ-8, as well as the Fibromyalgia Impact Questionnaire, Brief Pain Inventory, Hospital Anxiety and Depression Scale, and Tampa Kinesiophobia Scale. Internal consistency, confirmatory factor analysis, and construct validity were examined in the statistical analysis of the data obtained.

Results

The two-factor model created by exploratory factor analysis provided a better fit than the global factor model. Cronbach's alphas of both subscales of the CPAQ-8 were found to be 0.76 and 0.80; therefore, they provided internal consistency. The CPAQ-8 was found to be significantly correlated with all other scales compared.

Conclusion

The Turkish version of the CPAQ-8 is an assessment tool with sufficient validity in assessing pain acceptance levels in fibromyalgia patients experiencing chronic pain. Future studies are needed to evaluate the validity and reliability of the questionnaire in different chronic pain models.

The Effect of a Virtual Reality-Mediated Gamified Rehabilitation Program on Pain, Disability, Function, and Balance in Knee Osteoarthritis: A Prospective Randomized Controlled Study

Background: This prospective randomized controlled study is the first study that evaluates the disease-specific gamification through virtual reality (VR) glasses on pain, disability, functionality, and balance in knee osteoarthritis (OA). Materials and Methods: The demographic data of the patients were recorded. A total of 73 patients were divided into two groups (35 in experimental group and 38 in control group). All patients were evaluated with pain (visual analog scale [VAS]), functionality (Lysholm functional knee score [LFKS], 6 minutes walking test [6MWT]), disability (Western Ontario and McMaster Universities Arthritis Index [WOMAC]), and balance (Berg Balance Scale [BBS]) before treatment, after treatment (3th weeks), and 4 weeks after treatment (7th weeks). In the experimental group, plus the conservative treatment, a total of 15 sessions of a disease-specific gamification through VR glasses were applied. Results: VAS and WOMAC scores of the experimental group were lower at the 3th and 7th weeks than those of the control group (P = 0.005, P = 0.000), (P = 0.000). LFKS of the experimental group was higher at the 3th and 7th weeks than that of the control group (P = 0.005, P = 0.013). No difference was found between the groups in terms of 6MWTs (P > 0.05). BBS score of the experimental group was higher in the 7th week than that of the control group (P = 0.021). Conclusion: In knee OA, the disease-specific gamification through VR glasses added to the conservative treatment has a positive effect on pain, functionality, and balance. Side effects such as mild nausea, headache that did not last long, require additional treatment. In light of this, disease-specific gamification through VR glasses is effective and safe in knee OA, more studies that reveal the long-term effect on structural healing must be planned.

Are inflammatory parameters an independent predictor of hip osteoarthritis severity? A prospective cross-sectional study

OBJECTIVE

This study aimed to investigate the relationship between the presence of hip osteoarthritis and the neutrophil-lymphocyte ratio, platelet-lymphocyte ratio, monocyte-lymphocyte ratio, and neutrophil-monocyte ratio.

METHODS

Participants with hip osteoarthritis and healthy controls aged 45-75 years were recruited in the study. The participants with hip osteoarthritis were divided into two groups: mild/moderate hip osteoarthritis and severe hip osteoarthritis. Complete blood parameters of the participants were recorded, and neutrophil-lymphocyte ratio, neutrophil-monocyte ratio, monocyte-lymphocyte ratio, and platelet-lymphocyte ratio were calculated. Pain severity was evaluated using a visual analog scale.

RESULTS

A total of 76 participants with hip osteoarthritis and 59 healthy controls were included in the study. The mean age of the participants was 57.6±6.11 years. Mean neutrophil-lymphocyte ratio and neutrophil-monocyte ratio values were statistically significantly different between the hip osteoarthritis group and healthy control group (p<0.05). Platelet-lymphocyte ratio, monocyte-lymphocyte ratio, erythrocyte sedimentation rate, and C-reactive protein values were not significantly different between the groups. Also, there was no difference between all inflammatory parameters and hip osteoarthritis severity (p>0.05).

CONCLUSIONS

Neutrophil-lymphocyte ratio and neutrophil-monocyte ratio values were higher in patients with hip osteoarthritis than in healthy controls. Mean platelet-lymphocyte ratio, monocyte-lymphocyte ratio, erythrocyte sedimentation rate, and C-reactive protein values did not change according to the presence of hip osteoarthritis. Not all hematological indices give valuable information regarding the severity of hip osteoarthritis.

Pulmonary Rehabilitation in Coronavirus Disease 2019 Patients

Since coronavirus disease 2019 mainly affects the respiratory system, pulmonary rehabilitation has increased its importance during the novel coronavirus pandemic. Healthcare professionals must use appropriate personal protective equipment during rehabilitation of patients infected with severe acute respiratory syndrome coronavirus 2. Comorbidities of the patient should be taken into consideration while organizing the rehabilitation program. Clinical manifestations range from asymptomatic to acute respiratory distress syndrome. There is no need for pulmonary rehabilitation in asymptomatic patients. Pulmonary rehabilitation may be recommended in patients with mild-moderate disease. It is advised that patients be followed up during the rehabilitation period. Positioning and passive range of motion exercises are beneficial in preventing immobilization complications in patients with critical illness. Post-coronavirus disease 2019 rehabilitation program should be established according to the needs and functional levels of the patients.

Validity, reliability, and factor structure of the Istanbul Low Back Pain Disability Index in axial spondyloarthritis

OBJECTIVE

To investigate the validation and reliability of Istanbul Low Back Pain Disability Index (ILBPDI) in axial spondyloarthritis (Ax-SpA).

METHODS

Patients with Ax-SpA according to The Assessment of SpondyloArthritis International Society criteria were recruited. The validation was assessed by face, content, and construct (convergent and divergent) validities, whereas the reliability was assessed by internal consistency and test-retest reliability. Factor analysis was performed. Convergent validity was assessed by correlations of ILBPDI with functional parameters (The Bath Ankylosing Spondylitis Functional Index, The Dougados Functional Index, and The Health Assessment Questionnaire). Divergent validity was assessed by correlations of ILBPDI with non-functional parameters.

RESULTS

Two hundred forty patients were recruited. Cognitive debriefing showed ILBPDI to be clear, relevant, and comprehensive. Cronbach's alpha coefficient was 0.953. The test-retest reliability was good with the intraclass correlation coefficient of 0.870. ILBPDI was represented by three-factor groups of activity: axial bending, sitting/rest, and standing activities. ILBPDI had good correlations with the functional parameters (rho changes between 0.809 and 0.580), and it had poor or non-significant correlations with the non-functional parameters (absolute rho changes between 0.669 and 0.001).

CONCLUSION

ILBPDI is a practical, accurate, and non-time-consuming scale which is valid and reliable to evaluate the functional disability in patients with Ax-SpA.